Solitary Parathyroid Research Articles

ПЕРВИЧНЫЙ ГИПЕРПАРАТИРЕОЗ, ОБУСЛОВЛЕННЫЙ АДЕНОМОЙ ПАРАЩИТОВИДНОЙ ЖЕЛЕЗЫ, ЭКТОПИРОВАННОЙ В ТИМУС: ОПИСАНИЕ КЛИНИЧЕСКОГО НАБЛЮДЕНИЯ

Primary hyperparathyroidism (or PHPT) is a rare pediatric disease occurring in 1 case per 200 to 300 thousand children. The most common cause of PHPT in the adult population is a solitary parathyroid (PT) adenoma with up to 16% of PT adenomas having an ectopic location. There are no epidemiological data on pancreatic adenomas in pediatric population including atypically located ones, and clinical data are extremely scarce. This article describes a clinical observation of an adolescent patient with PHPT whose disease has been manifested with increased fragility and deformation of the bones of the skeleton. Only one year after the onset of primary symptoms a complex set of diagnostic measures was initiated, as a result of which a diagnosis was established: PHPT against the background of adenoma of the pancreas, ectopic in the left lobe of the thymus. The surgical treatment was carried out in the amount of thoracoscopic hemithymectomy which led to the relief of hyperparathyroidism. Despite the surgical intervention the systemic osteoporosis and persistent pathological changes in the bone skeleton that have been formed by the time of diagnosis require long-term observation and treatment of the patient by a pediatric endocrinologist, pediatric orthopedist and rehabilitologist. Thus, based on the presented clinical observation, the conclusion is as follows: in order to minimize the risk of disability in children and adolescents with PHPT it is extremely important to establish the correct diagnosis as early as possible coupled with the timely etiotropic and pathogenetic treatment.

Parathyroid Adenoma Presenting with Recurrent Abdominal Pain and Renal Calculi

Introduction: Parathyroid adenoma is the single most common cause of hyperparathyroidism. Reported incidence of parathyroid adenoma varies widely and is 30- 90%. Approximately 80% to 85% of patients with primary hyperparathyroidism were found to have solitary parathyroid adenoma.The hyperparathyroidism due to parathyroid adenoma may progress insidiously over several years and eventually presents as renal colic or symptoms may manifest over a considerably shorter period of time. Greater than 50% of patients present with nephrolithiasis or nephrocalcinosis. The present case report describes a 48 year old male patient with symptoms of abdominal pain.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Primary Hyperparathyroidism Focused on Molecular Pathogenesis.

Primary hyperparathyroidism (PHPT) is a common cause of hypercalcaemia. The most common lesion found in patients is the solitary benign parathyroid adenoma. Multiple parathyroid adenomas have also been reported. Parathyroid carcinomas are an uncommon cause of PHPT. In 15% of patients, all four parathyroid glands are involved and it may be associated with a familial hereditary syndrome, such as multiple endocrine neoplasia, types 1, 2A and 4. PHPT jaw tumour syndrome is associated with fibromas in the mandible and tumours can also be present in the kidneys and the uterus. No predisposing germline DNA variants in parathyroid adenomas have been demonstrated and only a few clonally altered genes that drive parathyroid tumorigenesis have been identified. Frequently parathyroid adenomas have HRPT2 gene mutations that are likely to be of pathogenetic importance. Mutations in the MEN1 gene (localised to 11q13) are responsible for multiple endocrine neoplasia 1. Multiple endocrine neoplasia 2A, which can be associated with medullary thyroid cancer, is due to a germline mutation of the RET proto-oncogene located on chromosome 10. In MEN1-like negative patients some of the germline mutations in this new susceptibility gene were due to gene CDKN1B (12p13). This new syndrome was classified as multiple endocrine neoplasia 4. In PHPT jaw tumour syndrome, HRPT2, the gene on the long arm of chromosome 1, is responsible for the syndrome. It is suggested to perform genetic testing in patients with PHPT below the age of 30 years, but at any age in patients presenting with multigland parathyroid disease.

PRIMARY HYPERPARATHYROIDISM (literature review)

Primary hyperparathyroidism is a common endocrine disorder in adults and asymptomatic hypercalcemia is its typical manifestation. Primary hyperparathyroidism is clinically symptomatic in younger patients who reveal signs of hypercalcemia, skeletal complications and/or nephrolithiasis. In most cases, primary hyperparathyroidism is caused by a solitary benign parathyroid adenoma, rarely by multiple adenomas. The involvement of all the four parathyroid glands, so-called parathyroid hyperplasia, occurs in approximately 10 % cases. Parathyroid carcinoma is exceedingly uncommon (less than 1 %). Surgery is the principal treatment method for most adult patients with primary hyperparathyroidism, apart from the cases associated with hereditary hypocalciuric hypercalcemia.

Radio-guided parathyroidectomy in patients with primary hyperparathyroidism and concomitant multinodular goiter

We investigated possible instances where the standard bilateral neck exploration for parathyroid adenoma may be omitted in primary hyperparathyroidism (pHPT) if preoperative diagnostics for the location have been performed. Ten patients underwent surgical treatment for pHPT and multinodular goiter between October 2006 and October 2008. Identification of the parathyroid adenomas' location with cervical ultrasound and (99m)technetium-sestamibi nuclear scanning ((99m)Tc-MIBI) was not possible in any of these patients. An extirpation of the parathyroid adenomas was performed with intraoperative use of the (99m)Tc-MIBI-guided probe technique. The median follow-up time was 17.5 months (range 2-30). Ten patients underwent an elective operation for solitary (n = 9) or dual (n = 1) parathyroid adenomas and concomitant thyroid disease. Definitive proof of the parathyroid adenomas was achieved in all of the patients without further neck exploration. The adenomas were 1.3 cm (range 1-2) in diameter. Calcium and parathyroid hormonal levels were reduced on the first postoperative day (P = 0.003). There were no postoperative complications. All patients were free from recurrence. The intraoperative probe technique is feasible in patients with pHPT and limited diagnostics for the location of parathyroid adenomas with concomitant goiter. This diagnostic technique identified the parathyroid adenoma in all cases, and thus rendered a bilateral neck exploration obsolete.

Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism

To evaluate the usefulness of the combination of Tc-sestamibi/Tc-pertechnetate subtraction scintigraphy (SS) and high-resolution neck ultrasonography (US) in patients with primary hyperparathyroidism (pHPT) undergoing parathyroidectomy. Ninety-one patients with proved pHPT were studied, excluding patients with persistent or recurrent disease. There were 65 (71.4%) women and 26 (28.6%) men, with a median age of 59 years (range 18-78 years). All patients underwent both SS and US prior to surgery, and the results were compared with operative and histological findings. The intraoperative quick-parathyroid hormone assay was available for 52 (57.1%) patients. When multiglandular disease was found, both SS and US were considered truly positive only when at least two enlarged parathyroid (PT) glands had been localized. Eighty-three (91.2%) solitary PT adenomas and three (3.3%) carcinomas were found. Moreover, two (2.2%) patients had a double adenoma and three (3.3%) patients had diffuse PT hyperplasia. The overall sensitivity of combined SS+US was 94.5% (86.8% and 80.4% for SS and US respectively). There was a significant (P<0.05, Student's t-test) difference in size between the PT glands correctly identified and undetected by SS, whereas the site of the removed PT tumors significantly (P<0.05, Fisher exact test) influenced only the US sensitivity. When the preoperative localization of the PT glands is chosen, the combination of SS and US represents a reliable noninvasive localization technique and should be considered for use in each patient with pHPT undergoing surgery.